What factors determine a woman's ability to get pregnant?
Infertility is strictly defined by the length of time a couple has been actively trying to get pregnant without success. Traditionally, infertility is diagnosed if one year of active trying has gone by. However, because fertility potential decreases with increasing age, the criteria may be modified as the age of the female increases. Therefore, if a woman 35-40 years old has been unsuccessful after 6 months, a fertility evaluation may be in order. For women over 40, it is appropriate to seek help after only 3-6 months, since the amount of time available for pregnancy is significantly limited. Finally, if a cycle day 3 FSH level greater than 10 is detected, a woman of any age should be evaluated for infertility. Read our information about woman’s age and fertility potential.
How do you determine my fertility potential?
The factor, which is most reliably related to a woman’s fertility potential, is her age. It is well known that the fertility rate decreases as a woman’s age increases. There is evidence that this begins as early as age 30. Clearly, by age 35 there is a significant drop off in fertility potential and there is a drastic decrease at age 40. By age 45, there is essentially little chance of attaining pregnancy using the woman’s own eggs and at that point an egg donor is usually required. The age factor is a reflection of the number of eggs left in the ovaries as well as the number of genetically normal eggs left. Whether or not a woman has been pregnant in the past also has some bearing on an individuals current fertility potential. If a pregnancy has occurred previously, is more likely that pregnancy can occur again, compared to someone who has never been pregnant. Finally, the condition of a woman’s uterus and fallopian tubes are very important and may be limiting if significant damage has taken place.
When should I seek the help of a fertility specialist?
Although age may be an easy indicator of the relative ease or difficulty a woman may have getting pregnant, it is only a guideline. The number of eggs and more importantly, number of genetically normal eggs left in the ovaries can vary at any age. Some women will become menopausal (out of eggs) prematurely and may be unable to get pregnant as young as age 30. There are also those women who may still have a large number of eggs left even when older than age 40. Therefore, age alone is a poor gauge of any woman’s ability to get pregnant. There are several objective indicators, which may help to further clarify the situation. In general, shortening of the menstrual cycle length is a sign of decreasing fertility potential. On average, menstrual cycle lengths of 28 to 35 days are the norm. When cycle lengths have been in this range and then shorten to less than 25 days, fertility may be declining. The status of the ovaries on cycle day 3 is probably the most reliable measure of fertility potential. The levels of Estrogen and FSH are usually reflective of the number of eggs in the ovary and the ease of getting them to ovulate. In general, the lower the FSH and Estrogen levels, the greater the number of eggs and therefore fertility potential. FSH should be less than 10 and Estrogen less than 75 for the best chance of pregnancy. These levels may fluctuate from cycle to cycle and should therefore be checked frequently if an elevated result is obtained. The number of small follicles present as seen by ultrasound is also correlated to fertility. Measurements of FSH and Estrogen without this information is not as useful, so an ultrasound examination is recommended to get the best idea of what the fertility potential may be.
Most general Obstetrician/Gynecologists can conduct the initial fertility evaluation and even some treatment. In many cases, the problem may be easily detected and corrected by something fairly simple. However, when the initial testing discloses a serious problem or if treatment has not been successful after several months, it may be time to consult with a fertility specialist. Specific situations which should prompt such a consultation include significant abnormalities of the male partners sperm, FSH levels greater that 10, 3 unsuccessful cycles of treatment with Clomiphene Citrate (Serophene or Clomid), treatment requiring injectable medications or the need for assisted reproductive procedures such as in Vitro Fertilization.
Are all Reproductive Endocrinologists the same?
A doctor who specializes in the treatment of infertility is called a Reproductive Endocrinologist (RE). This type of doctor has completed a residency-training program in Obstetrics and Gynecology and an accredited 2-year fellowship in Reproductive Endocrinology and Infertility. If a doctor has not had this training, he or she is not an RE.
How do I find a fertility specialist (RE)?
No. Just as in any other field of medicine, some RE’s are more accomplished than others. One way to find the best RE as in any medical specialty is to ask about Board Certification. For a subspecialist like an RE, there are two types of Board Certification which apply. First, the general Obstetrics and Gynecology Board examinations must be passed. These consist of a written and oral examination given one year apart and if passed, give the Board certification that a general Obstetrician/Gynecologist has. More importantly, another set of examinations specific for Reproductive Endocrinology follow. These written and oral examinations must be accompanied by the publication of a scientific paper in a peer reviewed medical journal which is written solely by the RE himself. The paper is reviewed critically by the examiners during oral examination. Only a select few RE’s in private practice are able to attain Board Certification in both Obstetrics/Gynecology and Reproductive Endocrinology and Infertility. These special physicians represent the elite of this field and therefore possess special abilities, which distinguish them from the rest of the non-certified RE’s.
How do I know what to look for in a fertility clinic?
The best way to find an RE is to ask your Obstetrician/Gynecologist or Primary Care Physician for a referral. These doctors know the RE’s in the area and since they have been entrusted with your medical care in the past, are still the best sources of information when this important decision is needed. Medicine has long been a field where direct appeals for patients in the form of advertising in magazines and newspapers have been discouraged by the medical establishment. Unfortunately, in the past few years there has been an embarrassing number of physicians who have chosen to market their practices by advertising money back guarantees, deceptive package deals and misleading claims of unsubstantiated IVF success rates. Fortunately, most people do not make important decisions regarding their healthcare by responding to gimmicks and advertising the likes of which are usually associated with the sale of used cars. When all else fails, ask your current doctor.
What factors are important when choosing an ART program?
A full service fertility clinic for the treatment of infertility should offer all forms of testing and treatment on site and should be open 7 days a week. Lately, there has been a trend for some fertility clinics to operate satellite offices in an attempt to appear larger. Unfortunately, this usually means that some of these offices are only open a few days each week with a skeleton staff. Medical charts may not be available when needed and a physician may not even be on the premises to make important decisions in a timely fashion. It is preferable to receive care in a fertility clinic that houses all laboratory facilities, medical records and staff including the physician so that consistent quality care can be given at all times. Ultrasound examinations, blood hormone testing, sperm preparation for insemination and all fertility procedures should be available on site whenever they are needed. There should also be an affiliation with a CAP certified Assisted Reproductive Technology (ART) laboratory when those services are needed.
First of all, the credentials of the Laboratory Director and Medical Director must be considered. An ART laboratory should have a director who is a Ph.D. with Certification as a High Complexity Laboratory Director (HCLD). Laboratory Directors without these credentials may lack the expertise required to insure the necessary level of quality control that is critical to the success of an ART program. The Medical Director of an ART laboratory should be a Reproductive Endocrinologist (RE) who is Board Certified in Obstetrics/ Gynecology and Reproductive Endocrinology and Infertility. Medical Directors who are not Board Certified Reproductive Endocrinologists may not have had formal training in ART, may have failed the examinations required for certification or in some unfortunate cases may have not even attempted to become certified. Board Certification is the ultimate demonstration of proficiency and accomplishment. It is your assurance that the physician recognizes the importance of excellence in the performance of his or her practice and exerts maximal effort to keep up with the latest advances in this rapidly changing field. Secondly, the laboratory should be certified by the College of American Pathologists (CAP) and should report their data to the Society of Assisted Reproductive Technology (SART).